Patient Education

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In children, localized scleroderma is more common and less severe than the generalized from of scleroderma, which is also called systemic sclerosis and severely affects internal organs.

Scleroderma can cause growth and joint problems in children.

There is no known cure, but treatments can control the disease or reduce associated problems.

Scleroderma means “hard skin.” Children with localized scleroderma often have involvement of the tissues below the skin, including muscle and bone. Besides the skin hardening, there can be changes in skin color and texture, and the underlying tissues may fail to grow normally. Localized scleroderma can occur in several different forms, including linear scleroderma (where the lesion appears as a line or streak) and circumscribed morphea (where the lesion appears as a roundish lesion). Most patients have the disease on just one part or side of their body. Early on, some lesions may have a red or purplish color that may be limited to the lesion border. Others may have a white or waxy appearance and feel hard.

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Because it is a complex disease, lupus requires treatment by or consultation with a rheumatologist, a doctor who is an expert in treating lupus and other rheumatic diseases.

People can live well with lupus if they actively work toward good health.

Systemic lupus erythematosus, referred to as SLE or lupus, is a chronic (long-term) disease that causes inflammation — pain and swelling. It is sometimes called the “great imitator,” because of people often confuse lupus with other health problems due to its wide range of symptoms.

In addition to affecting the skin and joints, it can affect other organs in the body such as the kidneys, the tissue lining the lungs (pleura) and heart (pericardium), and the brain. Most patients feel fatigue and have rashes, arthritis (painful and swollen joints) and fever.

Lupus flares vary from mild to serious. Most patients have times when the disease is active, followed by times when the disease is mostly quiet — referred to as a remission. Yet, there is much reason for hope. Improvements in treatment have greatly improved these patients’ quality of life and increased their lifespan.

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Lyme disease spreads only by a tick bite. Though the bite may go unnoticed, the infection usually starts with a painless, spreading rash where the tick had attached itself to the skin.

Noticing the early signs of Lyme disease and getting prompt treatment when they occur greatly reduces the severity and length of symptoms.

Even when the infection is found much later, antibiotic treatment is still successful for most people.

Lyme disease is an infection spread by the bite of certain types of ticks. If caught and treated early, the infection most often clears quickly. If not found until the later stages of infection, people with Lyme disease are more likely to still have symptoms (what you feel) after treatment. These include fatigue (feeling very tired), poor sleep, and muscle and joint pain.

Lyme disease results from the spread of Borrelia burgdorferi bacteria living inside infected ticks. These small ticks can attach to human skin and go unnoticed, feeding for a few days. During that time, the bacteria pass from the tick into the person, before the tick dislodges. Other infections spread by ticks may occur at the same time (co-infection) or separate from Lyme disease. These also require prompt medical care.

Treatment of Lyme disease is with certain antibiotics. In most cases, early-stage Lyme disease is treated successfully with two to three weeks of oral (by mouth) antibiotics. Most cases of early-stage Lyme disease need just two or three weeks of antibiotics, most experts agree. However, patients with arthritis (swelling of a joint) need longer treatment (four weeks) with oral antibiotics. If arthritis persists, they may need a second four-week course of oral or intravenous (often called IV) antibiotics. Infection involving the nervous system or heart also may require IV antibiotics.

Even when antibiotic treatment does not start until the later stages, it is still successful in most patients. However, early detection and treatment are important. People are more likely to have lingering symptoms after treatment if they do not get treatment promptly. These symptoms include fatigue, poor sleep, and muscle and joint pain. The name for this set of ongoing symptoms is post-Lyme disease syndrome.

The cause of post-Lyme disease syndrome is not known. Symptoms are similar to those that can occur after other infections and stressors to the body. Treatment with more antibiotics beyond the first standard treatment has not been proven to be of benefit. Only people with ongoing active infection (which is rare after earlier recommended antibiotic treatment) should receive additional antibiotic treatment. Most people with this syndrome will improve over time.

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I have been a patient of this practice for 28 yrs. and I feel that I am MOST fortunate to have received the very best care and treatment available. I have not enough words to express my appreciation, fondness and respect for Dr. Joel Kremer.

Dr. Toledo goes above and beyond for her patients. She treated me like a human being and not just another patient. She actually made eye contact with me, which so many other practitioners do not. I am very impressed with Dr. Toledo-Garcia!

I think Dr. Michaels is awesome. She spent so much time with me. She is really personable and not what I expected at all. Looking forward to seeing her again. I loved her tips!

I would recommend Dr. Shapiro and his nurse practitioner without any reservation whatsoever. I am extremely lucky to have Dr. Shapiro as my rheumatologist and that he has chosen over the years to continue to accept me as a patient. He is so professional, knowledgeable, trustworthy and kind.

I would recommend Dr. Hausner to anyone. She is a wonderful doctor. She listens to me and responds to my concerns/needs. She is compassionate, caring and very good at her job.

Dr. Greenstein has been my rheumatologist for 30 years. I couldn't imagine where my disease would be today without his knowledgeable, kind intervention and treatment! He literally has given me my life back.

I have been very impressed with Dr. Faisal Chaudhary. He is very knowledgeable and willing to listen to and discuss complementary strategies as well.

I have and continue to recommend your practice to anyone looking for a rheumatologist. Dr. Cavaliere is very caring and really takes the time to listen and best of all really makes appropriate changes to help my overall pain level.

I will continue to recommend your office because of my excellent visit with Rhonda Murphy, RPA and I will continue to request her. I learned so much about my different problem areas from her. She was so informative. It really was one of the best doctor visits I've ever had.

I definitely would recommend the practice. I have been seeing Mari Kaymakcian for over 3 years now and she is very thorough and understanding of my problems.

Your new office is gorgeous, accommodating and so pleasant to visit! It makes having to go to the doctor a pleasurable experience.

Dr. Cosgrove and her team give me peace of mind dealing with our medical problems in such a calm, cheerful and highly professional manner.